PMID- 34980685
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220429
IS  - 2093-0879 (Print)
IS  - 2093-0887 (Electronic)
IS  - 2093-0879 (Linking)
VI  - 28
IP  - 1
DP  - 2022 Jan 30
TI  - On-demand Versus Continuous Maintenance Treatment of Gastroesophageal Reflux 
      Disease With Proton Pump Inhibitors: A Systematic Review and Meta-analysis.
PG  - 5-14
LID - 10.5056/jnm21095 [doi]
AB  - BACKGROUND/AIMS: Long-term maintenance treatment of gastroesophageal reflux 
      disease (GERD) is commonly used to prevent relapse of reflux symptoms; however, 
      due to concerns about safety of long-term proton pump inhibitors (PPI) use, 
      on-demand therapy is recommended as a longterm treatment modality. We compared 
      the efficacy of on-demand and continuous PPI therapy for maintenance treatment of 
      patients with GERD using meta-analysis. METHODS: Core electronic databases were 
      searched for randomized controlled trials comparing on-demand and continuous 
      therapy in GERD patients. The primary outcome was treatment failure of 
      maintenance therapy, and the secondary outcomes included symptomatic relief, 
      patient satisfaction, and amount of PPI use. RESULTS: Overall, 11 studies were 
      selected in the systematic review and meta-analysis. Compared with continuous PPI 
      therapy, on-demand therapy showed similar outcomes for treatment failure (risk 
      ratio, 1.26; 95% confidence interval [CI], 0.76-2.07), particularly in the 
      non-erosive esophageal reflux disease and mild erosive reflux disease group (risk 
      ratio, 1.48; 95% CI, 0.39-5.63). In studies including severe esophagitis 
      patients, continuous PPI maintenance treatment was more effective (beta, 0.127 [95% 
      CI, 0.066-0.188]; P < 0.001). Severity of esophagitis was associated with higher 
      efficacies of continuous maintenance therapy. The amount of daily PPI use was 
      about half in the on-demand group compared to the continuous group (risk 
      difference -0.52; 95% CI, -0.62--0.42). CONCLUSIONS: On-demand PPI therapy shows 
      comparable efficacy to the continuous maintenance treatment in the non-erosive 
      esophageal reflux disease and mild erosive reflux disease group, and can 
      remarkably reduce the amount of PPI use. Therefore, on-demand therapy may be 
      preferentially recommended in the maintenance treatment of GERD unaccompanied by 
      severe esophagitis.
FAU - Kang, Seung Joo
AU  - Kang SJ
AD  - Department of Internal Medicine, Seoul National University Hospital Gangnam 
      Center, Seoul, Korea.
FAU - Jung, Hye-Kyung
AU  - Jung HK
AD  - Department of Internal Medicine, Ewha Womans University College of Medicine, 
      Seoul, Korea.
FAU - Tae, Chung Hyun
AU  - Tae CH
AD  - Department of Internal Medicine, Ewha Womans University College of Medicine, 
      Seoul, Korea.
FAU - Kim, Seung Young
AU  - Kim SY
AD  - Department of Internal Medicine, College of Medicine, Korea University, Seoul, 
      Korea.
FAU - Lee, Kwang Jae
AU  - Lee KJ
AD  - Department of Gastroenterology, Ajou University School of Medicine, Suwon, 
      Gyeonggi-do, Korea.
LA  - eng
PT  - Journal Article
PL  - Korea (South)
TA  - J Neurogastroenterol Motil
JT  - Journal of neurogastroenterology and motility
JID - 101530189
PMC - PMC8748841
OTO - NOTNLM
OT  - Gastroesophageal reflux
OT  - Maintenance
OT  - Proton pump inhibitors
COIS- Conflicts of interest: None.
EDAT- 2022/01/05 06:00
MHDA- 2022/01/05 06:01
PMCR- 2022/01/30
CRDT- 2022/01/04 06:01
PHST- 2021/05/14 00:00 [received]
PHST- 2021/07/30 00:00 [revised]
PHST- 2021/08/10 00:00 [accepted]
PHST- 2022/01/04 06:01 [entrez]
PHST- 2022/01/05 06:00 [pubmed]
PHST- 2022/01/05 06:01 [medline]
PHST- 2022/01/30 00:00 [pmc-release]
AID - jnm21095 [pii]
AID - jnm-28-1-5 [pii]
AID - 10.5056/jnm21095 [doi]
PST - ppublish
SO  - J Neurogastroenterol Motil. 2022 Jan 30;28(1):5-14. doi: 10.5056/jnm21095.